Basic Information
Provider Information
NPI: 1558323337
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOLLER
FirstName: MEGAN
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: D.P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: NUTTALL
OtherFirstName: MEGAN
OtherMiddleName: LEE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: D.P.T.
OtherLastNameType: 1
Mailing Information
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Practice Location
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Other Information
ProviderEnumerationDate: 04/05/2006
LastUpdateDate: 12/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT018023PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
183798101 HIGHMARK BLUE SHIELDOTHER
183798101 FIRST PRIORITY LIFE INSOTHER
269361900001 AMERIHEALTHOTHER
269361900001 KEYSTONE HEALTH EASTOTHER
5005856001 CAPITAL BLUE CROSSOTHER
269361900001 INDEPENDENCE BLUE CROSSOTHER
82017701 FIRST PRIORITY HEALTHOTHER
273466501 UNITED HEALTHCAREOTHER
861478801 CIGNA HEALTHCAREOTHER
42754801 HEALTHAMERICA/HEALTHASSUROTHER
P368699101 OXFORD HEALTH PLANSOTHER
217054401 MAMSIOTHER
4724101 GEISINGER HEALTH PLANOTHER
5005856001 KEYSTONE HEALTH CENTRALOTHER
723482201 AETNA PPOOTHER
P0035475101 MEDICARE RAILROADOTHER


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